Organization
RIVERSIDE HOSPITAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA J CLANTON (CONTRACTS MANAGER)
(574) 283-1107
Entity
Organization
Contact information
Practice address
533 N NILES AVE, SOUTH BEND, IN 46617-1919
(574) 283-1104
(574) 283-2178
Mailing address
533 N NILES AVE, SOUTH BEND, IN 46617-1919
(574) 283-1104
(574) 283-2178
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200264930A
—
IN
Enumeration date
11/21/2006
Last updated
02/01/2010
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